Implantable lead with flexible paddle electrode array

ABSTRACT

A neurostimulation system is disclosed herein. The neurostimulation system includes an implantable pulse generator and an implantable therapy lead configured to be electrically coupled to the implantable pulse generator. The implantable therapy lead includes a flexible paddle electrode array with flexible electrodes. Each flexible electrode has a segmented configuration having first and second electrode segments and a flexible bridge or living hinge joining together the first and second electrode segments.

FIELD OF THE INVENTION

The present disclosure relates to medical apparatus and methods. Morespecifically, the present disclosure relates to neurostimulation methodsand systems, and more particularly to paddle leads

BACKGROUND OF THE INVENTION

Application of electrical fields to spinal nerve roots, spinal cord, andother nerve bundles for the purpose of chronic pain control has beenactively practiced for some time. While a precise understanding of theinteraction between applied electrical energy and the neural tissue isnot understood, application of an electrical field to spinal nervoustissue (i.e., spinal nerve roots and spinal cord bundles) caneffectively mask certain types of pain transmitted from regions of thebody associated with the stimulated nerve tissue. Specifically, applyingelectrical energy to regions of the spinal cord associated with regionsof the body afflicted with chronic pain can induce “paresthesia” (asubjective sensation of numbness or tingling) in the afflicted bodilyregions. Thereby, paresthesia can effectively mask the transmission ofnon-acute pain sensations to the brain.

Each exterior region, or each dermatome, of the human body is associatedwith a particular spinal nerve root at a particular longitudinal spinalposition. The head and neck regions are associated with C2-C8, the backregions extend from C2-S3, the central diaphragm is associated withspinal nerve roots between C3 and C5, the upper extremities correspondto C5 and T1, the thoracic wall extends from T1 to T11, the peripheraldiaphragm is between T6 and T11, the abdominal wall is associated withT6-L1, lower extremities are located from L2 to S2, and the perineumfrom L4 to S4. In conventional neurostimulation, when a patientexperiences pain in one of these regions, a neurostimulation lead isimplanted adjacent to the spinal cord at the corresponding spinalposition. For example, to address chronic pain sensations that commonlyfocus on the lower back and lower extremities using conventionaltechniques, a specific energy field is typically applied to a regionbetween vertebrae levels T8 and T12. The specific energy field oftenstimulates a number of nerve fibers and structures of the spinal cord.By applying energy in this manner, the patient commonly experiencesparesthesia over a relatively wide region of the patient's body from thelower back to the lower extremities.

Positioning of an applied electrical field relative to a physiologicalmidline is also important. Nerve fibers extend between the brain and anerve root along the same side of the dorsal column that the peripheralareas the fibers represent. Pain that is concentrated on only one sideof the body is “unilateral” in nature. To address unilateral pain,electrical energy is applied to neural structures on the side of adorsal column that directly corresponds to a side of the body subject topain. Pain that is present on both sides of a patient is “bilateral”.Accordingly, bilateral pain is addressed through application ofelectrical energy along both sides of the column and/or along apatient's physiological midline.

Implantable leads have conductors extending there through that placedistal electrodes of the lead in electrical communication withimplantable pulse generators (IPGs) from which the implantable leadsdistally extend. The distal electrodes of the leads are positionedadjacent to pertinent nerves such that the electrodes deliverstimulation pulses to the nerves, those stimulation pulses originatingfrom the IPGs and transmitted to the distal electrodes via theconductors of the leads.

To supply suitable pain-managing electrical energy, multi-programmableIPGs enable a pattern of electrical pulses to be varied across theelectrodes of a lead. Specifically, such systems enable electrodes of aconnected stimulation lead to be set as an anode (+), as a cathode (−),or to a high-impedance state (OFF). As is well known, negatively chargedions and free electrons flow away from a cathode toward an anode.Consequently, a range of very simple to very complex electrical fieldscan be created by defining different electrodes in various combinationsof (+), (−), and OFF. Of course, in any instance, a functionalcombination must include at least one anode and at least one cathode(although in some cases, the “can” of the IPG can function as an anode).

Percutaneous leads and paddle leads are the two most common types oflead designs that provide conductors to deliver stimulation pulses froman implantable pulse generator (IPG) to distal electrodes adjacent tothe pertinent nerve tissue. Example commercially available leads includethe QUATTRODE™, OCTRODE™, LAMITRODE™, TRIPOLE™, EXCLAIM™, and PENTA™stimulation leads from St. Jude Medical, Inc.

A conventional percutaneous lead includes electrodes that substantiallyconform to the body of the lead. Due to the relatively small profile ofpercutaneous leads, percutaneous leads are typically positioned abovethe dura layer through the use of a Touhy-like needle. Specifically, theTouhy-like needle is passed through the skin, between desired vertebraeto open above the dura layer for the insertion of the percutaneous lead.

A conventional laminotomy or paddle lead has a paddle configuration andtypically possesses a plurality of electrodes (commonly, eight, orsixteen) arranged in columns. Due to their dimensions and physicalcharacteristics, conventional paddle leads may require a surgicalprocedure (a partial laminectomy) for implantation. Multi-column paddleleads enable more reliable positioning of a plurality of electrodes ascompared to percutaneous leads. Also, paddle leads offer a more stableplatform that tends to migrate less after implantation. Paddle leads arecapable of being sutured in place. Paddle leads also create auni-directional electrical field and, hence, can be used in a moreelectrically efficient manner than at least some known percutaneousleads.

Conventional laminotomy or paddle leads may be configured to employpaddle electrode arrays having a plurality of electrodes, which may bein the form of rectangular planar electrodes. Although a staggeredelectrode arrangement can provide superior electrode coverage ascompared to that of a non-staggered electrode arrangement, a paddleelectrode array with a staggered electrode arrangement will have reducedflexibility as compared to a similar paddle electrode array with anon-staggered electrode arrangement. The more rigid the paddle electrodearray, the more likely the paddle electrode array can result in traumato the epidural space in which it is implanted.

Accordingly, there is a need in the art for a paddle electrode arrayoffering improved electrode coverage while still offering appropriateflexibility.

SUMMARY

A neurostimulation system is disclosed herein. In one embodiment, theneurostimulation system includes an implantable pulse generator and animplantable therapy lead configured to be electrically coupled to theimplantable pulse generator. The implantable therapy lead includes aflexible paddle electrode array with flexible electrodes. Each flexibleelectrode has a segmented configuration having first and secondelectrode segments and a flexible bridge or living hinge joiningtogether the first and second electrode segments.

In one embodiment, the flexible paddle electrode array also includesnonflexible electrodes that do not extend across flex lines of theflexible paddle electrode array. The flex lines extend generallyperpendicular to the longitudinal length of the flexible paddleelectrode array to pass through the flexible bridges. The flex lines arelocations along the length of the flexible paddle electrode array wherethe array can flex. Because the nonflexible electrodes do not extendacross the flex lines, and the flexible bridges of the flexibleelectrodes are aligned with the flex lines such that the bridges can actas living hinges to allow the electrode segments of the flexibleelectrodes to flex relative to each other at their respective livinghinges, the flexible paddle electrode array can flex or bend along thevarious flex lines.

Another neurostimulation system is disclosed herein. In one embodiment,the neurostimulation system includes an implantable pulse generator andan implantable therapy lead configured to be electrically coupled to theimplantable pulse generator. The implantable therapy lead includes aflexible paddle electrode array that has a row of laterally alignedflexible electrodes and a row of laterally aligned nonflexibleelectrodes. The row of laterally aligned flexible electrodes at leastpartially contributes to the formation of a flex line in the flexiblepaddle electrode. The row of laterally aligned nonflexible electrodes islongitudinally offset from the row of laterally aligned flexibleelectrodes such the flex line does not extend across the row oflaterally aligned nonflexible electrodes.

In one embodiment, a flexible electrode of the flexible electrodes mayinclude a first electrode segment and a second electrode segmentspaced-apart from the first electrode segment. The flex line passesbetween the spaced-apart first and second electrode segments.

The flexible electrode of the flexible electrodes may further include aflexible living hinge joining the spaced-apart first and secondelectrode segments. The flex line passes through the flexible livinghinge. The flexible living hinge may include a V-shape or U-shape.

The flexible electrode may be of an integrated construction such that atleast one of the first electrode segment, the second electrode segmentor the flexible living hinge are separate pieces joined together duringmanufacturing of the flexible electrode. The joining together duringmanufacturing of the flexible electrode may include at least one ofwelding or crimping.

Alternatively, the flexible electrode may be of a unitary and continuousconstruction such that the first electrode segment, the second electrodesegment and the flexible living hinge are formed from a single materialpiece during manufacturing of the flexible electrode. The forming duringmanufacturing of the flexible electrode may include at least one ofstamping or laser cutting.

While multiple embodiments are disclosed, still other embodiments of thepresent invention will become apparent to those skilled in the art fromthe following detailed description, which shows and describesillustrative embodiments of the invention. As will be realized, theinvention is capable of modifications in various aspects, all withoutdeparting from the spirit and scope of the present invention.Accordingly, the drawings and detailed description are to be regarded asillustrative in nature and not restrictive.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A is a schematic diagram of the spinal cord and the nerve roots inrelation to the vertebral spinal canal.

FIG. 1B is a schematic diagram of a neurostimulation system including apaddle lead extending from an implantable pulse generator incommunication with a wireless programmer.

FIG. 1C is a schematic diagram of the paddle lead of FIG. 1B, whereinthe paddle lead has a flexible paddle electrode array.

FIG. 2 is an isometric view of the flexile paddle electrode array of thepaddle lead of FIG. 1C, as viewed from a patient contact side of theflexile paddle electrode array.

FIG. 3 is an isometric view of the flexile paddle electrode array ofFIG. 2, except as viewed from an electrically insulated side of theflexile paddle electrode array opposite the patient contact sideillustrated in FIG. 2.

FIG. 4A is an isometric view of an outer or patient contact side of anonflexible electrode of the flexible paddle electrode array of FIG. 2.

FIG. 4B is an isometric view of an inner side of the nonflexibleelectrode of FIG. 4A, the inner side being opposite the patient contactside.

FIG. 4C is a side elevation view of the nonflexible electrode of FIG.4A.

FIG. 5A is an isometric view of an outer or patient contact side of aflexible electrode of the flexible paddle electrode array of FIG. 2.

FIG. 5B is an isometric view of an inner side of the flexible electrodeof FIG. 5A, the inner side being opposite the patient contact side 62.

FIG. 5C is a side elevation view of the flexible electrode of FIG. 5A.

FIG. 6 is an enlarged view of a region of FIG. 3.

FIGS. 7A and 7B are plan views of a shortened coverage electrode arrayand an elongated electrode array, respectively.

DETAILED DESCRIPTION

Neurostimulation systems 5 and methods are disclosed herein. In additionto an implantable pulse generator (IPG) 310, the neurostimulation system5 also includes an implantable therapy lead 10 that is capable of beingcoupled to the IPG 310. As discussed in detail below, in one embodiment,the lead 10 includes a flexible paddle electrode array 11 that includesnonflexible electrodes 36 and flexible electrodes 38. Each flexibleelectrode 38 includes first and second electrode segments 68A, 68B and aliving hinge 70 that joins together the electrode segments 68A, 68B toallow the electrode segments 68A, 68B to flex or articulate relative toeach other about the living hinge 70, but still remain in solid contactwith patient tissue.

The nonflexible electrodes 36 are grouped into rows of laterally alignednonflexible electrodes 36 on the flexible paddle electrode array 11.Similarly, the flexible electrodes 38 are grouped into rows of laterallyaligned flexible electrodes 38 on the flexible paddle electrode array11. The even longitudinal spacing of the rows of laterally alignednonflexible electrodes 36 is offset or staggered from the evenlongitudinal spacing of the rows of laterally aligned flexibleelectrodes 38. Further, the living hinges 70 of each row of laterallyaligned flexible electrodes 38 are aligned along a flex or hinge line100 of the flexible paddle array 11. Since no portion of a nonflexibleelectrode 36 extends across these flex or hinge lines 100, the flexiblepaddle electrode array 11 has transverse lines of reduced rigidity orstiffness at these flex or hinge lines 100, thereby allowing theflexible paddle electrode array 11 to flex or deflect along its lengthat these hinge lines 100. Because of the living hinges 70, the staggeredarrangement of the rows of the nonflexible and flexible electrodes, andthe flex or hinge lines 100, the flexible paddle electrode array 11 isable to flex along its length, but be sufficiently rigid to maintain thenonflexible and flexible electrodes in adequate contact with patienttissue.

A. DEFINITIONS

Unless defined otherwise, technical and scientific terms used hereinhave the same meaning as commonly understood by one of ordinary skill inthe art to which this disclosure belongs. For purposes of the presentdisclosure, the following terms are defined below.

As used herein, the use of the word “a” or “an” when used in conjunctionwith the term “comprising” in the claims and/or the specification maymean “one”, but it is also consistent with the meaning of “one or more,”“at least one”, and “one or more than one”. Still further, the terms“having”, “including”, “containing” and “comprising” are interchangeableand one of skill in the art is cognizant that these terms are open-endedterms. Some embodiments may consist of or consist essentially of one ormore elements, method steps, and/or methods of the disclosure. It iscontemplated that any method or composition described herein can beimplemented with respect to any other method or composition describedherein.

As used herein, the use of the term “dorsal column” refers to conductingpathways in the spinal cord that are located in the dorsal portion ofthe spinal cord between the posterior horns, and which includes afferentsomatosensory neurons. The dorsal column is also known as the posteriorfuniculus.

As used herein, “spinal cord,” “spinal nervous tissue associated with avertebral segment,” “nervous tissue associated with a vertebral segment”or “spinal cord associated with a vertebral segment or level” includesany spinal nervous tissue associated with a vertebral level or segment.Those of skill in the art are aware that the spinal cord and tissueassociated therewith are associated with cervical, thoracic and lumbarvertebrae. As used herein, C1 refers to cervical vertebral segment 1, C2refers to cervical vertebral segment 2, and so on. T1 refers to thoracicvertebral segment 1, T2 refers to thoracic vertebral segment 2, and soon. L1 refers to lumbar vertebral segment 1, L2 refers to lumbarvertebral segment 2, and so on, unless otherwise specifically noted. Incertain cases, spinal cord nerve roots leave the bony spine at avertebral level different from the vertebral segment with which the rootis associated. For example, the T1 nerve root leaves the spinal cordmyelum at an area located behind vertebral body T8-T9 but leaves thebony spine between T11 and T12.

As used herein the term “chronic pain” refers to a persistent state ofpain experienced for a substantial amount of time (e.g., longer thanthree months).

As used herein the term “complex regional pain syndrome” or “CRPS”refers to painful conditions that usually affect the distal part of anupper or lower extremity and are associated with characteristic clinicalphenomena. CRPS is divided into two subtypes CRPS Type I and CRPS TypeII. Generally, the clinical characteristics of Type I are the same asseen in Type II. The central difference between Type I and Type II isthat Type II typically occurs following a sensory nerve injury whereasType I occurs in the absence of any known nerve injury.

B. ORGANIZATION OF NERVOUS SYSTEM

The nervous system includes two general components, the central nervoussystem, which is composed of the brain and the spinal cord, and theperipheral nervous system, which is composed of ganglia or dorsal rootganglia and the peripheral nerves that lie outside the brain and thespinal cord. Those of skill in the art will appreciate that thecomponents of the nervous system may be linguistically separated andcategorized, but functionally they are interconnected and interactive.

The central nervous system includes the brain and spinal cord, whichtogether function as the principal integrator of sensory input and motoroutput. In general terms, the brain consists of the cerebrum (cerebralhemispheres and the diencephalons), the brainstem (midbrain, pons, andmedulla), and the cerebellum. The spinal cord is organized intosegments, for example, there are eight cervical (C1-C8), 12 thoracic(T1-T12), five lumbar (L1-L5), five sacral (S1-S5), and one cocygeal(Co1) spinal segments. In adults, the spinal cord typically ends at thelevel of the L1 or L2 vertebral bones. As shown in FIG. 1A, which is ais a schematic diagram of the spinal cord and the nerve roots inrelation to the vertebral spinal canal, the nerve roots travel downwardto reach their exit points at the appropriate levels. Left and rightsensory and motor nerve roots arise from each segment of the spinal cordexcept for the C1 and Co1 segments, which have no sensory roots.Associated sensory and motor nerve roots fuse to form a single mixedspinal nerve for each segment. The mixed spinal nerves further fuse andintermingle peripherally to form plexuses and nerve branches.

The peripheral nervous system is divided into the autonomic system(parasympathetic and sympathetic), the somatic system, and the entericsystem. The term peripheral nerve is intended to include both motor andsensory neurons and neuronal bundles of the autonomic system, thesomatic system, and the enteric system that reside outside of the spinalcord and the brain. Peripheral nerve ganglia and nerves located outsideof the brain and spinal cord are also described by the term peripheralnerve.

C. OVERVIEW OF NEUROSTIMULATION SYSTEM

FIG. 1B is a schematic diagram of a neurostimulation system 5 includinga paddle lead 10, an implantable pulse generator (IPG) 310, and aprogrammer 320. The paddle lead 10 extends from the IPG 310. Theprogrammer 320 is in wireless communication with the IPG 310. An exampleof a commercially available IPG 310 is the Eon™ Rechargeable IPG fromSt. Jude Medical, Inc. (Plano, Tex.), although any suitable IPG, such asRF powered devices, could be alternatively employed.

FIG. 1C is a schematic diagram of the paddle lead 10 employed in thesystem 5 of FIG. 1B, according to one embodiment. The paddle lead 10includes a proximal end 14 and a distal end 16. The proximal end 14includes a connector end or assembly 18 with a plurality of electricallyconductive terminals 22. The distal end 16 includes a flexible paddleelectrode array 11 that includes a plurality of nonflexible electrodes36 and flexible electrodes 38 arranged within a substantially flat andthin paddle style structure 17. The electrodes 36, 38 are mutuallyseparated by the electrically insulative material of the paddle 17.Further details regarding the flexible paddle electrode array 11 and itsconstruction are given below.

A lead body 12 of the lead 10 extends between the flexible paddleelectrode array 11 and the connector end 18. Conductors 24, which areembedded within respective insulative sheaths 15 of the insulative leadbody 12, electrically connect the electrodes 36, 38 to the terminals 22.

The terminals 22 are preferably formed of a non-corrosive, highlyconductive material. Examples of such material include stainless steel,MP35N, platinum, and platinum alloys. In one embodiment, the terminals22 are formed of a platinum-iridium alloy.

Each conductor 24 is formed of a conductive material that exhibitsdesired mechanical properties of low resistance, corrosion resistance,flexibility, and strength. While conventional stranded bundles ofstainless steel, MP35N, platinum, platinum-iridium alloy, drawn-brazedsilver (DBS) or the like can be used, one embodiment uses conductors 24formed of multi-strands of drawn-filled tubes (DFT). Each strand isformed of a low resistance material and is encased in a high strengthmaterial (preferably, metal).

A selected number of “sub-strands” may be wound and coated with aninsulative material. With regard to the operating environment ofrepresentative embodiments, such insulative material protects anindividual conductor if its respective sheath is breached during use.

In addition to providing the requisite strength, flexibility, andresistance to fatigue, conductors 24 formed of multi-strands ofdrawn-filled tubes, in accordance with the above description, provide alow resistance alternative to other materials. Specifically, a strandedwire, or even a coiled wire, of approximately 60 cm and formed of MP35Nor stainless steel or the like may have a measured resistance in excessof 30 ohms. In contrast, for the same length, a wire formed ofmulti-strands of drawn-filled tubes could have a resistance less than 4ohms.

In the embodiment shown in FIG. 1C, the flexible paddle electrode array11 includes five columns and four rows of electrodes 36, 38 arranged ina grid configuration, for a total of twenty electrodes 36, 38. As can beunderstood from FIG. 1C and as discussed in greater detail below, thosecolumns may be three columns of non-flexible electrodes 36 and twocolumns of flexible electrodes 38, wherein the columns of non-flexibleelectrodes 36 are staggered more distally relative to the flexibleelectrodes 38.

Alternative numbers of columns and rows may be employed. For example, insome embodiments, thirty-two or more electrodes are distributed intomultiple rows and multiple columns. Also, every row need not contain thesame number of columns. For example, a number of rows can include a“tri-pole” design having three columns of electrodes while additionalrows can include five or more columns of electrodes to enable a greateramount of electrical field resolution. Regardless of the number ofcolumns and rows employed for the flexible paddle electrode array 11, aslong as the non-flexible electrodes 36 and flexible electrodes 38 arearranged such that the flexible paddle electrode array 11 has transverselines of reduced rigidity or stiffness at flex or hinge lines 100discussed in detail below, the flexible paddle electrode array 11 willbe able to flex or deflect along its length at those hinge lines 100,while maintaining the electrodes 36, 38 in adequate contact with thepatient tissue.

The multiple columns of electrodes 36, 38 enable lateral control of theapplied electrical field to stimulate the exact lateral position of thepertinent nerve fiber(s), as described herein. Specifically, it may bedesirable to selectively stimulate a given dorsal column fiber that isassociated with an afflicted region of the patient's body withoutaffecting other regions of the patient's body. The multiple columns ofelectrodes according to representative embodiments provide sufficientresolution to relatively finely control the stimulation of one orseveral specific fibers, as described herein. Additionally, the multiplecolumns provide a degree of positional tolerance during the surgicalplacement of the flexible paddle electrode array 11 within the epiduralspace, as any one of the columns may be used to stimulate the pertinentnerve fiber(s). Also, if the flexible paddle electrode array 11 isdisplaced relative to the pertinent nerve fibers subsequent toimplantation (e.g., due to lead migration), the stimulation patternapplied by a pulse generator can be shifted between columns tocompensate for the displacement.

The multiple rows of electrodes 36, 38 enable multiple pain locations tobe treated with a single implanted lead. Specifically, a first row canbe used to treat a first pain complaint (e.g., pain in the lowerextremities) and a second row can be used to treat a second painlocation (e.g., post-laminectomy pain in the back). Furthermore, byseparating the first and second rows by one or more “buffer” rows ofhigh-impedance electrodes, the stimulation in the first and second rowsmay occur on a substantially independent basis. Specifically, anodes inthe second row will have relatively minimal effect on the fielddistribution generated by cathodes in the first row.

In some embodiments, the flexible paddle electrode array 11 can beimplanted within a patient such that electrodes 36, 38 are positionedwithin the cervical or thoracic spinal levels. After implantation, anelectrode combination on a first row of electrodes can be determinedthat is effective for a first pain location with minimal effects onother regions of the body. The first pain location can be addressed bystimulating a specific dorsal column fiber due to the relatively fineelectrical field resolution achievable by the multiple columns. Then,another electrode combination on a second row of electrodes can bedetermined for a second pain location with minimal effects on otherregions of the body. The second pain location could be addressed bystimulating another dorsal column fiber as an example. After thedetermination of the appropriate electrodes for stimulation, a patient'sIPG 310, which is depicted in FIG. 1C, can be programmed to deliverpulses using the first and second rows according to the determinedelectrode combinations.

When determining the appropriate electrode configurations, the selectionof electrodes to function as anodes can often facilitate isolation ofthe applied electrical field to desired fibers and other neuralstructures. Specifically, the selection of an electrode to function asan anode at a position adjacent to another electrode functioning as acathode causes the resulting electron/ion flow to be limited to tissuesimmediately surrounding the two electrodes. By alternating through aplurality of anode/cathode combinations it is possible to improveresolution in the stimulation of dorsal column fibers. Also, it ispossible to confine the applied electrical field to or away from aperiphery of the flexible paddle electrode array 11.

The operation of anodes can also be used to hyperpolarize neural tissue.Depending on the anode amplitude and the proximity to the pertinentneural tissue, the hyperpolarization can be used to prevent selectedneural tissue from propagating action potentials. The hyperpolarizationcan also be used to prevent an adjacent cathode from initiatingpropagation of an action potential beginning at the selected neuraltissue.

Multiple columns of electrodes 36, 38 also enable lateral “steering” ofthe electrical field using a single channel pulse generator. A singlechannel pulse generator refers to a pulse generator that provides anequal magnitude pulse to each active electrode at a given time.Specifically, each electrode is either “active” (i.e., it is coupled tothe pulse generator output during pulse generation by a suitable gate orswitch) or “inactive” (i.e., the gate or switch does not couple theelectrode to the pulse generator output). Each “active” electrodeexperiences the same amplitude; only the polarity varies depending uponwhether electrode is set as a cathode or anode as defined by positionsof respective gates and/or switches. The steering of the electricalfield occurs by selecting appropriate states for each of electrodes 36,38.

The conductors 24 are carried in sheaths 15. In some embodiments, eachsheath 15 carries eight conductors 24. With only two sheaths with eightconductors each, there would only be sixteen conductors. To accommodatethe lower number of conductors than electrodes 36, 38, multipleelectrodes may be coupled to the same conductor (and, hence, to a commonterminal 22).

In some embodiments, other electrode designs can be employed to minimizethe number of conductors 24 required to support the various electrodes36, 38. For example, a relatively large number of electrodes (e.g.,thirty-two, sixty-four, and greater) could be utilized on the flexiblepaddle electrode array 11. The electrodes could be coupled to one orseveral electrical gates (e.g., as deposited on a flex circuit). Theelectrical gates can be controllably configured to couple each electrodeto a conductor carrying cathode pulses, to couple each electrode to ananode termination, or to maintain each electrode at a high impedancestate. The electrical gates could be controlled using a main controller,such as a logic circuit, on the flexible paddle electrode array 11 thatis coupled to a data line conductor 24. The data line conductorcommunicates signals from the IPG 310 that identify the desiredelectrode states, and the main controller responds to the signals bysetting the states of the electrical gates as appropriate.

In another embodiment, a cathode conductor line 24 and an anodeconductor line 24 are provided in one or several lead bodies 12 alongwith a plurality of optical fibers. The optical fibers are used to carryoptical control signals that control the electrode states. Specifically,the flexible paddle electrode array 11 includes photodetectors (e.g.,photodiodes) that gate connections to the anode conductor line and thecathode conductor line. The use of optical fibers to carry opticalcontrol signals may be advantageous, because the diameter of opticalfibers suitable for such functionality is smaller than electricalconductors 24. Therefore, a larger number of electrodes (as compared tousing a separate electrical conductor 24 for each electrode) can beindependently controlled while maintaining the lead body diameters at anacceptable size.

The sheaths 15 and the paddle support structure 17 of the flexiblepaddle electrode array 11 are preferably formed from a medical grade,substantially inert material, for example, polyurethane, silicone, orthe like. Importantly, such material should be non-reactive to theenvironment of the human body, provide a flexible and durable (i.e.,fatigue resistant) exterior structure for the components of the paddlelead 10, and insulate adjacent terminals 22 and/or electrodes 36, 38.

The flexible paddle electrode array 11 may be fabricated to possess asubstantially flat profile. Alternatively, the flexible paddle electrodearray 11 may have an arcuate or bowed profile. In some embodiments, awing structure or other type of stabilization structure extends alongone or both longitudinal sides of the paddle structure 17. Suchstabilization structures may be formed for the purpose of retaining theflexible paddle electrode array 11 within the central portion of theepidural space. In some embodiments, one or more electrodes 36, 38 maybe disposed on the stabilization structures. Regardless of whether theflexible paddle electrode array 11 has a substantially flat profile oran arcuate profile or is equipped with one or more stabilizationstructures, as long as the non-flexible electrodes 36 and flexibleelectrodes 38 are arranged such that the flexible paddle electrode array11 has transverse lines of reduced rigidity or stiffness at flex orhinge lines 100 discussed in detail below, the flexible paddle electrodearray 11 will be able to flex or deflect along its length at those hingelines 100, while maintaining the electrodes 36, 38 in adequate contactwith the patient tissue.

As can be understood from FIGS. 1B and 10, the paddle lead 10 is coupledto the IPG 310 by the lead connector assembly 18 of the paddle lead 10being received in the header ports 311 of the IPG 310. Each header port311 electrically couples the respective terminals 22 to a switch matrix(not shown) within the IPG 310.

The switch matrix selectively connects the pulse generating circuitry(not shown) of the IPG 310 to the terminals 22 of the paddle lead 10,and, hence to electrodes 36, 38. A sealed portion 312 of the IPG 310contains pulse generating circuitry, communication circuitry, controlcircuitry, and a battery (not shown) within an enclosure to protect thecomponents after implantation within a patient. The control circuitrymay include a microprocessor, one or more application specificintegrated circuits (ASICs), and/or any suitable circuitry forcontrolling the pulse generating circuitry. The control circuitrycontrols the pulse generating circuitry to apply electrical pulses tothe patient via the electrodes 36, 38 of the flexible paddle electrodearray 11 according to multiple pulse parameters (e.g., pulse amplitude,pulse width, pulse frequency, etc.). The electrodes 36, 38 are set tofunction as cathodes or anodes or set to a high-impedance state for agiven pulse according to the couplings provided by the switch matrix.The electrode states may be changed between pulses.

When the paddle lead 10 is initially implanted within the patient, adetermination of the set(s) of pulse parameters and the electrodeconfiguration(s) that may effectively treat the patient's condition ismade. The determination or programming typically occurs through aphysician's interaction with configuration software 321 executed on theprogrammer device 320, as indicated in FIG. 1B. The configurationsoftware 321 steps the physician through a number of parameters andelectrode configurations based on a trolling algorithm. In someembodiments, the electrode configurations are stepped through bylaterally “steering” the electrical field by moving the anodes and/orcathodes along a row of the paddle. The patient provides feedback to thephysician regarding the perceived stimulation that occurs in responsethe pulse parameters and electrode configuration(s). The physician mayeffect changes to the parameters and electrode configuration(s) untiloptimal pulse parameters and electrode configuration(s) are determined.The final pulse parameters and configurations are stored within the IPG310 for subsequent use. The pulse parameters and configurations are usedby the IPG 310 to control the electrical stimulation provided to thepatient via the paddle lead 10. Although single channel IPGs have beendescribed according to some embodiments, multiple current or voltagesource IPGs could alternatively be employed.

D. FLEXIBLE PADDLE ELECTRODE ARRAY

FIG. 2 is an isometric view of the flexile paddle electrode array 11 ofthe lead of FIG. 1C, as viewed from a patient contact side 30 of thearray 11. FIG. 3 is an isometric view of the array 11 of FIG. 2, exceptas viewed from an electrically insulated side 32 of the array 11opposite the patient contact side 30 illustrated in FIG. 2. As shown inFIGS. 2 and 3, the paddle electrode array 11 includes a planar flexiblesubstrate 34, non-flexible electrodes 36, flexible electrodes 38, and anenclosure 40. The planar flexible substrate 34 and enclosure 40 can besaid to form a substantially flat and thin paddle style structure 17.The nonflexible electrodes 36 and flexible electrodes 38 are arrangedwithin the paddle style structure 17. The electrodes 36, 38 are mutuallyseparated by the electrically insulative material of the paddle 17.

The planar flexible substrate 34 may be formed of polyether ether ketone(PEEK), Fiberglass, or Liquid Crystal Polymer. The substrate 34 may havea thickness of between approximately 0.007″ and approximately 0.1″, awidth of between approximately 0.37″ and approximately 0.5″, and alength of between approximately 0.7″ and approximately 2.0″. Thesubstrate 34 includes a patient contact side 44 and an electricallyinsulated side 46 opposite the patient contact side 44. These sides 44,46 of the substrate 34 respectively correspond to the patient contactside 30 and the electrically insulated side 32 of the array 11.

As illustrated in FIGS. 2 and 3, longitudinally extending long slots 42extend through the thickness of the substrate 34 to daylight at thepatient contact side 44 and opposite electrically insulated side 46 ofthe substrate 34. The long slots 42 run parallel to a longitudinal axisof the flexible paddle electrode array 11. The long slots 42 have alength of between approximately 0.20″ and approximately 0.30″ and awidth of between approximately 0.025″ and approximately 0.38″.

Similarly, as can be understood from FIG. 3, longitudinally extendingshort slots 48 extend through the thickness of the substrate 34 todaylight at the patient contact side 44 and opposite electricallyinsulated side 46 of the substrate 34, although, as can be understoodfrom FIGS. 2 and 3, the short slots 48 are hidden by the electrodes 36,38 on the patient contact side 44 of the substrate 40. The short slots48 run parallel to the longitudinal axis of the flexible paddleelectrode array 11. The short slots 48 have a length of betweenapproximately 0.05″ and approximately 0.10″ and a width of betweenapproximately 0.015″ and approximately 0.025″.

Except as noted below, the enclosure 40 extends coextensively about theentirety of all surfaces of the substrate 34 and the electrodes 36, 38supported on the substrate 34. The exception to this statement is theplanar faces 50 of the electrodes 36, 38 on the patient contact side 30of the paddle 11. These electrode faces 50 extend through the enclosure40 to be exposed for making electrical contact with patient tissue, ascan be understood from FIG. 2.

As can be understood from FIGS. 1C-3, the paddle electrode array 11extends from the lead body 11. The enclosure 40 may be a continuous orgenerally continuous extension of one or more insulation layers of thejacket of the lead body 12. The jacket of the lead body 12 and theenclosure 40 may be in the form of one or more insulation layers. Suchinsulation layers may be fabricated of silicone rubber, polyurethane,silicone rubber-polyurethane-copolymer (SPC), polytetrafluoroethylene(“PTFE”), and/or other suitable polymers. The lead body 12 and electrodearray 11 include many internal components, including electricalconductors 24 extending through the lead body 12 and electrode array 11from the electrical contacts 22 of the lead connector assembly 18 to theelectrodes 36, 38 supported on the electrode array 11. The insulationlayers of the lead body 12 and enclosure 40 isolate these internalcomponents of the lead body 12 and paddle array 11 from each other andthe surrounding environment.

The patient contact side 30 includes exposed electrode faces 50 that areconfigured to contact patient tissue and administer electrical energy tothe patient tissue and/or sense electrical signals from the patienttissue. The electrically insulated side 32 of the array 11 is oppositefrom the patient contact side 30 and has a continuous and unbroken layerof the enclosure 40 extending over it such that no electrical contactcan be established with the electrodes 36, 38 by patient tissue cominginto contact with the electrically insulated side 32.

For a discussion regarding the nonflexible electrodes 36 employed in theelectrode array 11, reference is made to FIGS. 4A-4C. FIG. 4A is anisometric view of an outer or patient contact side 52 of a nonflexibleelectrode 36 of the flexible paddle electrode array 11 of FIG. 2. FIG.4B is an isometric view of an inner side 54 of the nonflexible electrode36 of FIG. 4A, the inner side 54 being opposite the patient contact side52. FIG. 4C is a side elevation view of the nonflexible electrode 36 ofFIG. 4A.

As shown in FIGS. 4A-4C, the patient contact side 52 of the nonflexibleelectrode 36 includes a planar face 50, and the inner side 54 of thenonflexible electrode 36 includes another planar face 56 opposite theplanar face 50 of the patient contact side 52. As illustrated in FIG. 2,the planar face 50 of the patient contact side 52 is not covered by theenclosure 40 and, as a result, serves as the exposed surface 50 of theelectrode 36 through which the electrode 36 administers and/or senseselectrical signals. As can be understood from FIGS. 2, 3 and 6, which isan enlarged area of FIG. 3, the planar face 56 of the inner side 54abuts against the patient contact side 44 of the substrate 34 ingenerally planar surface contact. While a short slot 48 may openunderneath the planar face 56 of the inner side 54, the enclosure 40extends over the entirety of the electrically insulated side 46 of thesubstrate 34. As a result, the planar face 56 of the inner side 54 iselectrically isolated and does not serve as a surface through which theelectrode 36 may administer and/or sense electrical signals.

As indicated in FIGS. 4A-4C, the nonflexible electrode 36 includes asingle continuous rectangular body 58 that includes the two planarsurfaces 50, 56. At the opposite ends of the body 58 are folded overtabs 59. As can be understood from FIGS. 2 and 3, these tabs 59 may beemployed for welding or otherwise affixing the electrode 36 to thesubstrate 34 and the respective electrical conductors 24 that extendfrom the contacts 22 of the lead connector assembly 18 and through thebody 12 and array 11 to the electrode 36.

For a discussion regarding the flexible electrodes 38 employed in theelectrode array 11, reference is made to FIGS. 5A-5C. FIG. 5A is anisometric view of an outer or patient contact side 62 of a flexibleelectrode 38 of the flexible paddle electrode array 11 of FIG. 2. FIG.5B is an isometric view of an inner side 64 of the flexible electrode 38of FIG. 5A, the inner side 64 being opposite the patient contact side62. FIG. 5C is a side elevation view of the flexible electrode 38 ofFIG. 5A.

As indicated in FIGS. 5A-5C, the flexible electrode 38 includes adiscontinuous or segmented rectangular body 68 having a firstrectangular body segment 68A joined via a flexible bridge 70 to a secondrectangular body segment 68B. Each body segment 68A, 68B includes arespective pair of planar surfaces 60A, 68A and 69B, 68B.

As illustrated in FIG. 5C, the flexible bridge 70 is V-shaped orU-shaped and protrudes outwardly from the inner side 64 of the electrode38. As shown in FIGS. 5A-5C, the U-shaped flexible bridge 70 isapproximately the same thickness as the body segments 68A, 68B, but hasa width that is approximately half as wide or less than the width of thebody segments 68A, 68B. The U-shaped flexible bridge 70 has arcuate orcurved transitions between itself and the adjoining body segments 68A,68B. Further the U-shaped flexible bridge 70 has an arcuate or curvedtransition at its extreme apex, which projects outwardly from the innerside 64 of the electrode 38 a distance that slightly exceeds that of thetabs 69.

Folded over tabs 69 are at the opposite ends of the segmented body 68.As can be understood from FIGS. 2, 3 and 6, these tabs 69 may beemployed for welding or otherwise affixing the electrode 38 to thesubstrate 34 and the respective electrical conductors 24 that extendfrom the contacts 22 of the lead connector assembly 18 and through thebody 12 and array 11 to the electrode 38.

As shown in FIGS. 5A-5C, the patient contact side 62 of the flexibleelectrode 38 includes planar faces 60A, 60B. Each such face 60A, 60B ispart of a respective rectangular body segment 68A, 68B. Similarly, theinner side 64 of the flexible electrode 38 includes planar faces 66A,66B opposite the planar faces 60A, 60B of the patient contact side 62.Each such face 66A, 66B is part of a respective rectangular body segment68A, 68B.

As illustrated in FIG. 2, the planar faces 60A, 60B of the patientcontact side 62 are not covered by the enclosure 40 and, as a result,serve as the exposed surfaces 60A, 60B of the flexible electrode 38through which the flexible electrode 38 administers and/or senseselectrical signals. As can be understood from FIGS. 2, 3 and 6, theplanar faces 66A, 66B of the inner side 64 abut against the patientcontact side 44 of the substrate 34 in generally planar surface contact.While a short slot 48 opens underneath the planar faces 66A, 66B of theinner side 64, and while the flexible bridge 70 extends through theshort slot 48, the enclosure 40 extends over the entirety of theelectrically insulated side 46 of the substrate 34. As a result, theplanar faces 66A, 66B of the inner side 64 and the flexible bridge 70are electrically isolated and do not serve as surfaces through which theelectrode 38 may administer and/or sense electrical signals.

As can be understood from FIGS. 2, 4A-4C, and 5A-5C, in one embodiment,each nonflexible electrode 36 has an overall length of betweenapproximately 0.18″ and approximately 0.28″, and an overall width ofbetween approximately 0.026″ and approximately 0.042″. Each flexibleelectrode 38 has an overall length of between approximately 0.26″ andapproximately 0.29″, and an overall width of between approximately0.026″ and approximately 0.042″.

Each electrode segment 68A, 68B has an overall length of betweenapproximately 0.11″ and approximately 0.12″. Each flexible electrode 38also has a gap distance over which the bridge 70 extends betweenimmediately adjacent ends of the segments 68A, 68B that is betweenapproximately 0.02″ and approximately 0.03″.

End-to-end spacing between immediately adjacent electrodes in the samecolumn is between approximately 0.08″ and approximately 0.2″.Side-to-side spacing between immediately adjacent electrode columns isbetween approximately 0.02″ and approximately 0.04″.

The electrodes 36, 38 are formed of an electrically conductive andbiocompatible material. Examples of such candidate electrode materialsinclude stainless steel, MP35N, platinum, and platinum alloys. In oneembodiment, the electrodes 36, 38 are formed of a platinum-iridiumalloy.

As can be understood from FIGS. 1C-6, the implantable therapy lead 10includes a flexible paddle electrode array 11 with flexible electrodes38. Each flexible electrode 38 has a segmented configuration havingfirst and second electrode segments 68A, 68B and a flexible bridge orliving hinge 70 joining together the first and second electrode segments68A, 68B. As noted above, the flexible bridge 70 may be V-shaped orU-shaped and have a width that is less than a width of the firstelectrode segment 68A or the second electrode segment 68B.

In one embodiment, the flexible electrode 38 is of an integratedconstruction such that the electrode segments 68A, 68B and the livinghinge 70 are manufactured of one or more individual pieces that arejoined together via, for example, welding or crimping. In anotherembodiment, the flexible electrode 38 is of a unitary and continuousconstruction such that the electrode segments 68A, 68B and the livinghinge 70 are formed from a single piece of material via stamping, lasercutting or other methods. As a result, the flexible electrode 38 have aunitary construction such that the segments 68A, 68B and the livinghinge 70 are not individual components that are joined together duringthe manufacturing process, but are of a single, unitary and continuouspiece of material to form a flexible electrode 38 of a continuous andunitary construction.

Regardless of how the flexible electrode 38 is manufactured andregardless of whether it is of an integrate construction or an integralconstruction, the living hinge 70 allows the flexible electrode 38 toflex along the hinge 70 while still being a one-piece electrode 38.Accordingly, the flexible electrode 38 only requires a single feederelectrical conductor contact and does not require a jumper wire betweenthe two electrode segments 68A, 68B.

The flexible paddle electrode array 11 also includes a substrate 34 onwhich the flexible electrodes 38 are supported. The substrate 34includes a short slot 48 that extends through the thickness of thesubstrate 34, and the flexible bridge 70 is located in the short slot70, as shown in FIG. 6.

As illustrated in FIGS. 2-3, the flexible paddle electrode array 11 alsoincludes nonflexible electrodes 36 that do not extend across flex lines100 of the flexible paddle electrode array 11. The flex lines 100 extendgenerally perpendicular to the longitudinal length of the array 11 topass through the flexible bridges 70. In other words, the flex lines 100extend laterally across the array 11 to pass through the flexiblebridges 70.

The flex lines 100 may be considered lines of reduced stiffness orrigidity in the flexible paddle electrode array 11 on account of thereduced stiffness or rigidity provided by the laterally aligned livinghinges 70. The flex lines 100 are locations along the length of theflexible paddle electrode array 11 where the flexible paddle electrodearray 11 can flex. Because the nonflexible electrodes 36 do not extendacross the flex lines 100, and the flexible bridges 70 of the flexibleelectrodes 38 are aligned with the flex lines 100 such that the bridges70 can act as living hinges 70 to allow the electrode segments 68A, 68B(see FIGS. 5A-5C) of the flexible electrodes 38 to flex relative to eachother at their respective living hinges 70, the flexible paddleelectrode array 11 can flex or bend along the various flex lines 100.Thus, as can be understood from FIGS. 2 and 3, the flexible electrodes38 allow for staggered rows of electrodes on the flexible paddleelectrode array without increasing stiffness between the rows ofelectrodes.

As indicated in FIGS. 2 and 3, the flexible electrodes 38 are part of aplurality of flexible electrodes 38 evenly spaced along at least onecolumn line (i.e., longitudinally extending line) that is generallyparallel with a longitudinal axis of the flexible paddle electrode array11. Similarly, the nonflexible electrodes 36 are part of a plurality ofnonflexible electrodes 36 evenly spaced along at least another columnline (i.e., longitudinally extending line) that is generally parallelwith the longitudinal axis of the flexible paddle electrode array 11.

These column lines of flexible electrodes 38 and nonflexible electrodes36 are laterally offset from each other. In one embodiment, there may betwo column lines of flexible electrodes 38 and three column lines ofnonflexible electrodes 36. The column lines of flexible electrodes 38and nonflexible electrodes 36 are arranged in an alternatingconfiguration running laterally across the flexible paddle electrodearray 11. The flexible electrodes 38 are evenly spaced apart from eachother, as is also the case with the nonflexible electrodes 36. Theflexible electrodes 38 are staggered along a length of the flexiblepaddle electrode array 11 relative to the nonflexible electrodes 36. Inone embodiment, each of the two column lines of flexible electrodes 38includes four flexible electrodes 38, and each of the three column linesof nonflexible electrodes 36 includes four nonflexible electrodes 36.Such an embodiment can also be said to have four row lines (i.e.,transversely extending lines) of two flexible electrodes 38 that arelaterally or transversely space apart from each other, and four rowlines (i.e., transversely extending lines) of three nonflexibleelectrodes 36 that are laterally or transversely spaced apart from eachother, as can be understood from FIG. 2.

The flexible paddle electrode array 11 and its components can beconfigured as depicted in FIGS. 1C-6 and dimensioned as discussed above.In other embodiments, the array 11 and its components may have otherarrangements. For example, as illustrated in FIG. 7A, in one embodiment,the flexible paddle electrode array 11 may employ an electrode arraythat is shortened or longitudinally compressed. The paddle structure 17can be curved or flat. The electrode array may extend over alongitudinal length of approximately 37 mm and, as a result, besubstantially short of the full length of the underlying paddlestructure 17. The paddle structure 17 may have a width of approximately9.5 mm and the array width may be approximately 9 mm. Electrode columnspacing and electrode row spacing may be approximately 1 mm andapproximately 5 mm, respectively. The electrodes 36, 38 may beapproximately 4 mm long by approximately 1 mm wide. The nonflexibleelectrodes 36 may be longitudinally staggered relative to the flexibleelectrodes 38 with stagger overlap of approximately 0.5 mm.

In another embodiment, as depicted in FIG. 7B, the flexible paddleelectrode array 11 may employ an electrode array that is elongated orlongitudinally extended. The paddle structure 17 can be curved or flat.The electrode array may extend over a longitudinal length ofapproximately 45 mm and, as a result, extend nearly the full length ofthe underlying paddle structure 17. The paddle structure 17 may have awidth of approximately 9.5 mm and the array width may be approximately 9mm. Electrode column spacing and electrode row spacing may beapproximately 1 mm and approximately 4.5 mm, respectively. Theelectrodes 36, 38 may be approximately 6.5 mm long by approximately 1 mmwide. The nonflexible electrodes 36 may be longitudinally staggeredrelative to the flexible electrodes 38 with stagger overlap ofapproximately 1 mm.

In general, while the invention has been described with reference toparticular embodiments, modifications can be made thereto withoutdeparting from the spirit and scope of the invention.

What is claimed is:
 1. A neurostimulation system comprising: animplantable pulse generator; and an implantable therapy lead configuredto be electrically coupled to the implantable pulse generator andcomprising a flexible paddle electrode array comprising a flexibleelectrode comprising first and second electrode segments and a flexibleliving hinge joining together the first and second electrode segments,which are spaced apart from each other.
 2. The system of claim 1,wherein the flexible living hinge comprises a V-shape or U-shape.
 3. Thesystem of claim 1, wherein the flexible electrode is of an integratedconstruction such that at least one of the first electrode segment, thesecond electrode segment or the flexible living hinge are separatepieces joined together during manufacturing of the flexible electrode.4. The system of claim 3, wherein the joining together duringmanufacturing of the flexible electrode comprises at least one ofwelding or crimping.
 5. The system of claim 1, wherein the flexibleelectrode is of unitary and continuous construction such that the firstelectrode segment, the second electrode segment and the flexible livinghinge are formed from a single material piece during manufacturing ofthe flexible electrode.
 6. The system of claim 5, wherein the formingduring manufacturing of the flexible electrode comprises at least one ofstamping or laser cutting.
 7. The system of claim 1, wherein theflexible living hinge comprises a width that is less than a width of thefirst electrode segment or the second electrode segment.
 8. The systemof claim 1, wherein the flexible paddle electrode array furthercomprises a substrate on which the flexible electrode is supported, thesubstrate comprising a slot extending through a thickness of thesubstrate, the flexible living hinge being located in the slot.
 9. Thesystem of claim 1, wherein the flexible paddle electrode array furthercomprises a nonflexible electrode that does not extend across a flexline of the flexible paddle electrode array, the flex line extendingthrough the flexible living hinge.
 10. The system of claim 9, whereinthe flexible electrode is part of a plurality of flexible electrodesevenly spaced along at least one line that is generally parallel with alongitudinal axis of the flexible paddle electrode array, and thenonflexible electrode is part of a plurality of nonflexible electrodesevenly spaced along at least another line that is generally parallelwith the longitudinal axis of the flexible paddle electrode array. 11.The system of claim 10, wherein the at least one line is laterallyoffset from the at least another line.
 12. The system of claim 11,wherein the plurality of flexible electrodes are staggered along alength of the flexible paddle electrode array relative to the pluralityof nonflexible electrodes.
 13. The system of claim 12, wherein the atleast one line of flexible electrodes comprises two lines of flexibleelectrodes, and the at least another line comprises three lines ofnonflexible electrodes.
 14. The system of claim 13, wherein the twolines of flexible electrodes are arranged in an alternatingconfiguration with the three lines of nonflexible electrodes runninglaterally across the flexible paddle electrode array.
 15. The system ofclaim 14, wherein each of the two lines of flexible electrodes comprisesfour flexible electrodes, and each of the three lines of nonflexibleelectrodes comprises four nonflexible electrodes.
 16. A neurostimulationsystem comprising: an implantable pulse generator; and an implantabletherapy lead configured to be electrically coupled to the implantablepulse generator and comprising a flexible paddle electrode arraycomprising: a row of laterally aligned flexible electrodes, the row oflaterally aligned flexible electrodes at least partially contributing tothe formation of a flex line in the flexible paddle electrode; and a rowof laterally aligned nonflexible electrodes longitudinally offset fromthe row of laterally aligned flexible electrodes such the flex line doesnot extend across the row of laterally aligned nonflexible electrodes.17. The system of claim 16, wherein a flexible electrode of the flexibleelectrodes comprises a first electrode segment and a second electrodesegment spaced-apart from the first electrode segment, the flex linepassing between the spaced-apart first and second electrode segments.18. The system of claim 17, wherein the flexible electrode of theflexible electrodes further comprises a flexible living hinge joiningthe spaced-apart first and second electrode segments, the flex linepassing through the flexible living hinge and further wherein theflexible electrode is of unitary and continuous construction such thatthe first electrode segment, the second electrode segment and theflexible living hinge are formed from a single material piece duringmanufacturing of the flexible electrode; and wherein the forming duringmanufacturing of the flexible electrode comprises at least one ofstamping or laser cutting.
 19. The system of claim 18, wherein theflexible living hinge comprises a V-shape or U-shape.
 20. The system ofclaim 18, wherein the flexible electrode is of an integratedconstruction such that at least one of the first electrode segment, thesecond electrode segment or the flexible living hinge are separatepieces joined together during manufacturing of the flexible electrodeand further wherein the joining together during manufacturing of theflexible electrode comprises at least one of welding or crimping.